Introduction: The impact of pregnancy on relapse activity and disability progression in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has not been fully clarified. In this study, we aimed to evaluate the impact of pregnancy on disease activity and disability in AQP4-Ab+ NMOSD and MOGAD and also to assess the effect of these two disorders on obstetric outcomes.
Methods: A retrospective longitudinal multicenter study of 71 women (AQP4-Ab+ NMOSD: 55; MOGAD: 16) were analyzed. Linear mixed-effects models were used to assess longitudinal changes in Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR) across pregnancy-related time points (pre-pregnancy, during pregnancy, postpartum).
Results: Expanded disability status scale (EDSS) remained stable during pregnancy but increased at last follow-up for both groups (for NMOSD p=0.002, for MOGAD p=0.042). Higher pre-pregnancy ARR and younger maternal age predicted greater postpartum disability in AQP4-Ab+ NMOSD patients, while for MOGAD patients, pre-pregnancy ARR was associated with later EDSS worsening. No significant change in ARR was observed across pregnancy-related periods in either group. Obstetric complications were rare. Miscarriage rates were low in both groups (AQP4-Ab+ NMOSD: 1.8%, MOGAD: 6.2%), with no major neonatal abnormalities.
Conclusion: Pregnancy was not associated with an increased relapse rate but was followed by long-term EDSS worsening in both NMOSD and MOGAD, particularly in patients with high pre-pregnancy disease activity. Obstetric outcomes were generally favorable.
Keywords: annualized relapse rate, disability progression, myelin